Section 1 Section 1 Introduction: Effective As of March 1, 2020

3DEO Inc Health and Welfare Benefit Plan - Wraparound
Summary Plan Description (“SPD”) and Plan Document

Effective as of March 1, 2020
Section 1 Introduction
3DEO Inc (the “Company” or “Employer”) has established the 3DEO Inc Health & Welfare Benefit Plan (the “Plan”) for the exclusive
benefit of the Company's eligible employees and their eligible dependents. In accordance with the Employee Retirement Income
Security Act of 1974, as amended (“ERISA”), this document serves as the plan document and summary plan description (“SPD”) for
the Plan. This plan document and SPD “wraps around” the underlying group insurance or any HMO contracts and related
Certificates of Coverage (“COCs”) or Evidences of Coverage (“EOCs”) under which benefits are provided under this Plan, and hereby
amends and restates the Plan in its entirety effective as of March 1, 2020. This document sets forth the terms of the Plan in effect
as of March 1, 2020 and governs the provision of benefits for claims incurred on or after that date. Exhibit A lists all of the benefits
and coverages available under the Plan to eligible employees (note: a benefit or coverage that is described in this document may
not be available to you; a benefit or coverage is only available if it is listed in Exhibit A and if you meet applicable eligibility and/or
enrollment requirements). The benefits provided under the Plan are more specifically described in these COCs or EOCs that are
provided automatically to you as separate documents after enrollment in such benefits or in applicable exhibits of this document.
For any self-insured benefit listed in Exhibit A, please refer to the applicable exhibit to this document for a description of the benefit
and terms governing the provision of such benefit. Note: As provided in Exhibit A, not all of the benefits made available by the
Company are subject to ERISA. These benefits are NOT a part of the Plan and any description of the benefit in this document is
included for convenience only.
Together with the underlying group insurance or HMO contracts and related COCs or EOCs which are incorporated herein by
reference, this plan document and SPD (and any summaries of material modifications you may later receive) describes the benefits
that are available under the Plan and requirements to obtain such benefits, including eligibility, enrollment and claim
requirements, and also provides you with certain information as required by ERISA and other applicable law. This SPD is not an
employment contract and does not guarantee any benefits or current or future employment. No employee, dependent, participant
or beneficiary has a right to any benefit beyond what is described in the Plan (including those materials that are incorporated by
reference). If there is any conflict between this document and the terms of any applicable insurance or HMO contract, EOC or COC
with respect to the provision of benefits, that document and not this plan document and SPD will control. Moreover, to the extent
that any statement or representation, whether oral or otherwise, of a Company employee, any delegate of the Company, including
the contract administrator Gusto or any of Gusto's employees, or any other person regarding the benefits of the Plan, conflicts with
this document or any applicable insurance or HMO contract, EOC or COC, the terms of this document, insurance or HMO contract,
EOC or COC will control. In all cases, the terms of this plan document and SPD (and any and all documents incorporated by
reference) control.
The Plan intends to be administered to comply with ERISA, the Internal Revenue Code, the Affordable Care Act, the Health
Insurance Portability and Accountability Act (“HIPAA”), COBRA (and any applicable state continuation laws), Mental Health Parity and
Addiction Equity Act, Newborns' and Mothers' Health Protection Act, Women's Health and Cancer Rights Act, and other applicable
law and such laws' implementing regulations and related guidance. Keep a copy of this document with your EOC and/or COC for
your reference.
If you have any questions that are not answered by this SPD, please contact:
3DEO Inc or the third party administrator that has contracted with the Company to administer the day-to-day operations of the
Plan, Gusto at benefits@gusto.com or (800) 936-0383.
NOTE: In this document, any reference to “you” or “your” means an employee, dependent, participant or beneficiary while any
reference to ”we“, ”us“ or “our” means the Company.
Section 2 General Information About Plan

Name of Plan: 3DEO Inc Health and Welfare Benefit Plan
Type of Plan: The Plan is a health and welfare benefit plan that may provide medical, dental, vision, life insurance, accidental death
and dismemberment and/or disability benefits.
Plan Number: 501
Plan Administrator and Plan Sponsor:

3DEO Inc
(800) 683-8526
14000 Van Ness Ave, Suite C
Gardena, CA 90249
The Company is the Plan Administrator and is the “named fiduciary” of the Plan within the meanings of ERISA Sections 3(16)(A) and
402(a), respectively. The Company has the sole, exclusive and maximum discretionary authority to control and manage the
operation and administration of the Plan, including the sole and exclusive authority to interpret, construe and administer the Plan.
The Company may delegate to any committee or a third party service provider, including an insurance company or HMO, the
discretionary authority to determine eligibility and/or claims and appeals regarding the receipt of benefits and to interpret plan
language and resolve any ambiguities. The Company may also engage legal counsel, accountants, consultants or any other service
provider to assist it in the administration of the Plan. The decisions of the Plan Administrator and its delegates are final and binding
on all persons and will be given the maximum deference permitted by law. With respect to the insured benefits listed in Exhibit A,
the Company has delegated the sole and exclusive discretionary authority to interpret the terms of the applicable insurance or
HMO contract and related COC or EOC and to determine claims for the benefits each has agreed to provide pursuant to the
applicable group insurance or HMO contract with the Company, to the applicable insurer or HMO. Such insurer or HMO has the
sole financial responsibility for providing such insured benefits and is the ”named fiduciary“ with respect to the determination of
claims and appeals for the benefit the insurer or HMO has agreed to provide under the Plan. With respect to any self-insured
benefits listed in Exhibit A, the Company has delegated the authority to determine claims to the claims administrator designated by
the Company, but has reserved the discretionary authority for itself to determine any appeal of any denied claim. Any final
determination by the Plan Administrator, claims administrator or insurer or HMO is binding on all parties.
The Company has delegated the day-to-day administrative functions of the Plan related to enrollment/disenrollment and other
non-discretionary functions to Gusto. Note: The Company is the Plan Administrator and “named fiduciary” of the Plan within the
meanings of ERISA Section 3(16)(A)(i) and ERISA Section 402(a)(2), not Gusto.
Plan Sponsor's Employer Identification Number: 812701081
Agent for Service of Legal Process:

3DEO Inc
14000 Van Ness Ave, Suite C
Gardena, CA 90249
Plan Effective Date: March 1, 2020
Plan Funding and Source of Contributions
Premiums and other contributions for the Plan's benefits are paid in part by the Company and by employees for the benefits for
which the employee is eligible and which the employee elects. The Company determines contribution amounts in its sole discretion
to cover the expected cost of insurance premiums and to defray the administrative expenses of the Plan; such amounts are
subject to change, at the sole discretion of the Company, and are provided in applicable enrollment materials or other materials.
Premium or other contribution costs that exceed the Company contribution are paid by the employee on a pre-tax basis via payroll
deduction pursuant to a cafeteria plan intended to comply with Internal Revenue Code Section 125, except where required by law
to be paid on a post-tax basis . Any applicable premium for non-tax dependent(s) will be deducted on a post-tax basis.
Contribution amounts are subject to change by the Company at any time. Employees generally will receive advance notice of any
change.
All contributions and any other payments made under or on behalf of the Plan are made from the Company's general assets
directly to the insurers and/or HMOs that have contracted with the Company to provide Plan benefits or other providers to pay
other benefits or expenses of the Plan. No trust or separate account has been established to hold or transmit any contribution or
payment to, from or on behalf of the Plan. Insured benefits are funded by the applicable insurer or HMO that has contracted to
provide such benefits. Benefits that are self-insured are funded from the Company's general assets. Any such determination of any
claim or appeal for any insured or self-insured benefit by the applicable claim administrator, shall be final and binding. Note: To
the extent permitted by applicable law, any refund, rebate, dividend, experience adjustment, or other similar payment under any
group insurance or HMO contract with the Company relating to any Plan benefit shall be used to pay for any combination of Plan
benefits, premiums and/or administrative expenses as determined by the Company in its sole discretion. Furthermore, no
participant or employee has a vested right to receive any portion of such funds or any benefit under the Plan unless required
under applicable law.
Amendment and Termination
Although the Company intends to operate the Plan indefinitely, the Company reserves the right, in its sole and absolute discretion
to amend or terminate the Plan in whole or in part (including any benefit, contribution amount or insurance or HMO contract) at
any time for whatever reason, without advance notice to any person by a written instrument executed by an authorized
representative of the Company or by any other appropriate action by the Company. If a benefit is provided pursuant to an
insurance or HMO contract, the Company may amend the applicable benefit by changing the insurer, HMO or the applicable policy
or contract at any time in its sole and complete discretion. Any amendment generally will not reduce the benefits to which the
participant may be entitled for a claim that is incurred prior to the effective date of the amendment.
Non-Assignment of Benefits
No benefit or right to receive a benefit under the Plan or any other right under the Plan or under applicable law (including, but not
limited to, the right to file a claim or appeal or commence civil proceedings, or obtain plan documents) may be assigned, sold,
transferred or given away, unless the applicable insurance or HMO contract permits such assignment. Note: Neither a direction to
pay a provider nor a provider's right to receive payment from an insurer or HMO pursuant to this Plan is considered an
assignment. Any right to benefits under the Plan may not be attached, garnished or seized for the payment of any debt, court
judgment or obligation of any kind except as otherwise required by law.
Section 3 Plan Benefits

The benefits available under the Plan are listed in Exhibit A; NOTE: any insured benefits are provided pursuant to the applicable
group insurance or HMO contract. The benefits are described in this document or in separate EOCs or COCs or other booklets all
of which are furnished (and are available upon written request) as separate documents and are a part of this Plan document and
SPD and are prepared by the applicable insurer or HMO that has agreed to provide such benefit under the Plan. These documents
describe: (a) additional eligibility requirements; (b) payment requirements, including, but not limited to, premiums and cost-sharing
(deductibles, copayments, coinsurance, and out-of-pocket limits); (c) benefits available and the terms and conditions governing
such benefits, including but not limited to, the services and supplies covered (including benefits provided pursuant to the
Affordable Care Act, if required), provider network and non-network requirements, benefit amounts and maximums, limits
(including visit, inpatient day and dollar limits), exclusions, prior authorization requirements, and medical management standards
and guidelines; (d) procedures for filing claims and appeals for denied claims and other available levels of review; (e) coordination
of benefits and third party reimbursement and subrogation requirements. All benefits are subject to the terms and conditions of
the Plan and the applicable insurance or HMO contract, if any. Any self-insured benefits listed in Exhibit A are described in
applicable exhibits to this document - see Exhibit A for the applicable reference. Any benefit received from a life or disability policy
may require the beneficiary to handle any related tax consequences. In some cases the insurance carrier may coordinate these tax
consequences on behalf of the beneficiary. Beneficiaries should review with their appropriate tax professional.
Where a benefit involves the use of network providers (also sometimes referred to as “PPO”, “EPO”, or “preferred providers”), the
Plan will provide listings of such providers to participants automatically and without charge as one or more separate documents or
by electronic document access via the Internet. Where a network is involved, the EOC or COC will include provisions governing the
use of such providers, primary care providers or providers of specialty services, the composition of the network and whether and
under what circumstances coverage is provided for emergency or out-of-network services.
Section 4 Eligibility
Unless otherwise stated, all regular, full-time employees who work at least 30 hours per week and who are on the U.S. payroll of
the Company are eligible to participate in the Plan. For purposes of the Plan's medical coverage, “full-time employee” status will be
determined in accordance with the applicable method for determining “full-time employee” status under the Affordable Care Act, if
applicable and/or state law, where applicable, by the Company in its sole discretion.
If dependent coverage is available for a particular benefit or coverage as provided in the applicable EOC, COC, or as described by
each benefit in Exhibit A, an employee may enroll eligible dependents in such coverage. Eligible dependents include an employee's
lawful spouse under applicable state law (“state” includes a foreign jurisdiction having the legal authority to sanction marriage), but
not a spouse who is legally separated from the employee, or registered domestic partner or partner under a state-sanctioned civil
union under applicable state law, and children (natural, adopted, stepchildren, or those for whom you have legal custody by court
order, up to the age of 26, at least, or older in accordance with state law) of eligible employees. A child placed with you for
adoption will be considered under the same terms and conditions as apply in the case of dependent children who are your natural
children. Also eligible for applicable health coverage is any child covered under a Qualified Medical Child Support Order (QMCSO)
as defined by applicable law and determined under the QMCSO procedures, a copy of which is available upon request to
participants and beneficiaries, without charge, from the Plan Administrator. Note: Coverage for a dependent, other than COBRA
continuation coverage or state continuation coverage (when applicable), is available only if the employee is also eligible for the
same coverage. Notify the Plan immediately if a dependent no longer meets the definition of a “dependent” as provided earlier in
this paragraph (for example, upon divorce or legal separation). If notification is not timely provided, you may be responsible for
any expenses incurred by the ineligible dependent and may be required to reimburse the Company, insurer or HMO, as applicable
for such expenses or related premium payments.
Note: Additional eligibility requirements may apply to a particular benefit; see the applicable EOC, COC, and Exhibit A for the
applicable insured benefit for further information (for example, evidence of insurability for life insurance coverage). At a minimum,
an individual must meet the applicable requirements above to qualify for coverage. Furthermore, the Company, insurer, HMO or a
delegate may require you to verify the eligibility of any and all dependents you enroll in the Plan at any time. If you fail to timely
submit documentation confirming the dependent's eligibility upon request, coverage for the dependent may be terminated
immediately or on a retroactive basis, subject to applicable law.
Section 5 Enrollment and Effective Date of Coverage

To obtain coverage for any benefit for which you are eligible under the Plan, you must timely enroll yourself and your eligible
dependents by completing and submitting an enrollment form and salary reduction agreement specifying the coverage(s) you elect
for yourself and/or your eligible dependents and your agreement to reduce your compensation accordingly to pay for such
coverage, to the Plan Administrator in the time and manner required by the Company. NOTE: By completing and submitting an
enrollment form (electronic or otherwise), you will be deemed to have provided true and accurate information on the form,
including, but not limited to, the eligibility of those dependents you enroll, and you will be deemed to acknowledge the Plan's right
to rely on the information provided. If you fail to timely enroll when initially eligible, you may not be able to enroll in coverage until
the next open enrollment period or upon the occurrence of a HIPAA Special Enrollment Event or “change in status” event, as
applicable. You may enroll yourself and your eligible dependents in all benefits for which you are eligible at the following times:
Initial Enrollment Period: During the 30-day period after you meet the applicable requirements for eligibility, you may elect
one or all of the benefits for which you and/or your dependents are eligible. Coverage will generally become effective not
later than 90 days after the date you meet the Plan's requirements for eligibility provided you timely enrolled in coverage,
see each individual benefit in Exhibit A for more details. Note: For your coverage to be effective, you must be actively at
work on the first day coverage would otherwise become effective. If you are not actively at work on that date, coverage will
become effective on the first day you return to work (note: for purposes of the Plan's medical coverage only, if you are not
at work because of illness or injury on the first day coverage would otherwise become effective, you will be considered
“actively at work” on that date and coverage will commence).
Open Enrollment Period: Each year, the Company provides for an annual open enrollment period during which you may
enroll yourself and any dependents in any benefit or coverage for which you and/or your dependents are eligible. You may
make new elections by completing a new enrollment form and salary reduction election or continue the same or most
similar elections you made previously by taking no action unless the Company's enrollment materials state otherwise.
Coverage generally will commence as of the first day of the next Plan Year.
HIPAA Special Enrollment Period and “Change in Status” Events: Benefit elections for medical, dental and/or vision coverage
for a Plan Year may not be changed until the next Open Enrollment period except if a “change in status” event occurs and
the election change is consistent with the “change in status.” You must notify the Plan Administrator in writing within 30
days (or 60 days as provided below) of the following “change in status” events to change your election and/or enroll yourself
and/or eligible dependents in the Plan or a particular coverage to be effective as of the first day of the month that follows
the month the election change is made, unless noted otherwise below (notification via the Gusto third-party website will
meet the written notice requirement):
For Health Plan Benefits (if offered): A judgment, decree or court order requires you to provide coverage for a
dependent, including a QMCSO or National Medical Support Notice; or
For Health Plan Benefits (if offered): You experience a HIPAA Special Enrollment Right that is any of the following:
You acquire a new dependent through marriage, birth adoption or placement for adoption (note: in the case
of a child acquired via birth, adoption or placement for adoption, coverage for you and/or your dependents
will be effective as of the date of the child's birth, adoption or placement for adoption); or
You or your dependent exhaust COBRA coverage under another plan;
You or your dependent involuntarily loses coverage under an individual insurance plan, including
Marketplace or Exchange coverage;
You or your dependent loses eligibility under another group health plan coverage for any of the following
reasons other than the failure to pay premiums or for cause: legal separation, divorce, death, termination of
employment, a reduction in hours of employment, termination of Employer contributions towards the other
coverage, ceasing to reside, live or work in the service area of an HMO if no other coverage is available under
the other plan, a dependent ceasing to qualify as a dependent under the other plan, and when a lifetime
limit on all benefits is met or exceeded; or
You or your dependent gains eligibility for premium assistance for coverage under Medicaid or Children's
Health Insurance Program (“CHIP”) (note: you must notify the Plan within 60 days of date eligibility is gained);
or
You or your dependent loses eligibility for coverage under a Medicaid or CHIP program (note: you must
notify the Plan within 60 days of losing eligibility).
For Health Plan Benefits, Health FSA, and Dependent Care FSA (if offered): Your employment status changes that
causes you to lose eligibility under the Plan (you may revoke your election);
For Health Plan Benefits, Health FSA, and Dependent Care FSA (if offered): Your spouse's employment changes such
that your spouse becomes eligible to participate in his/her employer's plan (you may change your election to drop
coverage for you and/or your spouse to enroll in the spouse's employer's plan);
For Health Plan Benefits (if offered): You lose your status as full-time employee during a “stability period” provided
under Section 4980H of the Internal Revenue Code you may revoke your election if you state to the Plan that you
will enroll in Marketplace or Exchange coverage;
For Health Plan Benefits (if offered): You or your dependent move outside the service area of the HMO in which you
are enrolled under the Plan and are no longer eligible to participate in the HMO (you may change your election to
drop coverage and/or enroll in other available similar coverage);
For Health Plan Benefits (if offered): You or your dependent becomes enrolled in Medicare or Medicaid (coverage for
the Medicare or Medicaid enrollee may be canceled);
For Health Plan Benefits (if offered): You or your dependent loses eligibility for Medicare or Medicaid (former
Medicare or Medicaid enrollee may be enrolled in coverage under Plan);
For Health Plan Benefits, Health FSA, and Dependent Care FSA (if offered): If the Family Medical Leave Act (“FMLA”)
applies to the Company, you may revoke your election for any unpaid FMLA leave. Upon a return from FMLA leave,
you may re-elect coverage under the Plan;
For Health Plan Benefits and Dependent Care FSA (if offered), but not Health FSA (if offered): If medical, dental or
vision coverage under a benefit package option significantly changes in cost, or, with respect to the Dependent Care
FSA, your dependent care provider increases costs significantly, you may either increase or decrease your
contribution amount, as applicable (or drop coverage under the benefit package option whose cost increased and
enroll in another benefit package option that provides similar coverage if such other coverage is available or drop
coverage if no such option is available);
vision coverage under a benefit package option is significantly curtailed without a loss of coverage (e.g., there is a
significant increase in the deductible, copay, or out-of-pocket cost sharing limit) or, with respect to the Dependent
Care FSA, your dependent care provider significantly reduces coverage/services, you may revoke your coverage
under the benefit package option and enroll in other benefit package option that provides similar coverage if such
other coverage is available;
vision coverage under a benefit package option is significantly curtailed with a loss of coverage (e.g., elimination of
the benefit package option in which the employee is enrolled, an HMO ceasing to be available in the area where the
employee resides, substantial decrease in medical care providers available under the plan – such as a major hospital
or significant number of physicians leaving a provider network, or reduction in the benefits for a specific type of
medical condition or treatment for which the employee or dependent is currently in a course of treatment) or, with
respect to the Dependent Care FSA, your provider ceases to provide services, you may revoke coverage under the
benefit package option and enroll in another benefit package option that provides similar coverage if such other
coverage is available or drop coverage if no other coverage is available;
For Health Plan Benefits (if offered): If coverage under another group health plan changes, you may change your
enrollment, increase benefits, revoke your election or decrease benefits, provided the change is consistent with the
other plan's coverage change;
For Health Plan Benefits (if offered): If the Plan adds or significantly improves a benefit package option mid-year,
you may revoke your election under another benefit package option and enroll in the new or significantly improved
benefit package option.
Unless otherwise specified, coverage following timely enrollment due to a “change in status event” will become effective as of the
first day of the month after your election change, except that coverage for a newly born or adopted child (and any other
dependents enrolled at the same time as the newborn or adopted child) will be retroactive to the date of birth or adoption.
Individuals who are enrolled pursuant to a HIPAA Special Enrollment Right will be offered all of the benefit packages available to
similarly situated individuals who enroll when they are first eligible. This means that you will be able to change your medical
option. Such change will be permissible as long as you and your dependents are eligible for such coverage. Note: All election
changes will be administered in accordance with the Internal Revenue Code and related regulations and HIPAA.
Section 6 Coverage Disqualification, Ineligibility, Termination or Loss

Coverage for any benefit or coverage will terminate if you no longer meet the applicable eligibility requirements. Coverage may
also terminate if you fail to pay your share of any premium, if your hours drop below the required eligibility threshold, if you submit
a false claim, etc. Coverage for your spouse and dependents stops when your coverage stops. Your coverage, as well as your
spouse's and/or dependents' coverage, will also stop for other reasons specified above or in the applicable EOC or COC.
Section 7 COBRA or State Continuation Coverage

To comply with the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”), the Plan may include a continuation of
coverage option. COBRA applies to employers with twenty (20) or more employees on a typical business day in the preceding
Calendar Year. Additionally, continuation coverage may be available to employees of employers with less than 20 employees in
accordance with state law. COBRA is available to certain Plan participants whose health care coverage(s) under the Plan would
otherwise terminate. Plan participants should review the applicable COC or EOC or contact their COBRA Administrator for
governing details. The following is only a summary of the major features of the federal law. Different rules may apply depending
on the governing state and applicable law.
NOTE: Life insurance, accidental death and dismemberment benefits and short-term or long-term disability benefits (if part of the
employer's Plan) are not eligible for continuation under COBRA. COBRA rights apply to medical, dental, vision and other health plan
coverage available under the Plan. Other health plan coverage continuation may depend on whether your employer is subject to
COBRA or a state continuation program.
Definitions
1. Qualified Beneficiary. An individual who, on the day before a Qualifying Event, is covered under the Plan by virtue of being
either a covered employee, or the covered dependent spouse or child of a covered employee. Any child who is born to or
placed for adoption with a covered employee during a period of COBRA continuation coverage. Such child has the right to
immediately elect, following the child's birth or placement for adoption, under the COBRA continuation, coverages the
covered employee has at the time of the child's birth or placement for adoption, the same coverage that a dependent child
of an active employee would receive. The employee's Qualifying Event date and resultant continuation coverage period also
apply to the child.
An individual who is not covered under the Plan on the day before a Qualifying Event because he/she was denied Plan
coverage or was not offered Plan coverage and such denial or failure to offer constitutes a violation of applicable law. The
individual will be considered to have had the Plan coverage and will be a “Qualified Beneficiary” if that individual
experiences a Qualifying Event.
Exception: An individual is not a Qualified Beneficiary if the individual's status as a covered employee is attributable to a
period in which he/she was a nonresident alien who received no earned income from the employer that constituted income
from sources within the United States. If such an employee is not a Qualified Beneficiary, then a spouse or dependent child
of the employee is not a Qualified Beneficiary by virtue of the relationship to the employee.
Note: Under federal law, domestic partners (and their children) do not have independent COBRA election rights. However,
some group health providers (e.g. insurance carriers) will extend COBRA-like election rights to such individuals as if they
were COBRA qualified beneficiaries.
2. Qualifying Event. Any of the following events which would result in the loss of health coverage under the Plan in the
absence of COBRA continuation coverage:
voluntary or involuntary termination of employee's employment for any reason other than employee's gross
misconduct;
reduction in an employee's hours of employment to non-eligible status. In this regard, a Qualifying Event occurs
whether or not employee actually works and may include absence from work due to a disability, temporary layoff or
leave of absence where Plan coverage terminates but termination of employment does not occur. If a covered
employee is on FMLA unpaid leave, a Qualifying Event occurs at the time the employee fails to return to work at the
expiration of the leave, even if the employee fails to pay his/her portion of the cost of Plan coverage during the FMLA
leave;
for an employee's spouse or child, employee's entitlement to Medicare. For COBRA purposes, “entitlement” means
that the Medicare enrollment process has been completed with the Social Security Administration and the
employee has been notified that his/her Medicare coverage is in effect;
for an employee's spouse or child, the divorce or legal separation of the employee and spouse;
for an employee's spouse or child, the death of the covered employee;
for an employee's child, the child's loss of dependent status (e.g. a child reaching the maximum age limit).
3. Non-COBRA Beneficiary. An individual who is covered under the Plan on an “active” basis (i.e. an individual to whom a
Qualifying Event has not occurred).
Notification
If the Employer is the Plan Administrator and if the Qualifying Event is the employee's termination/reduction in hours, death, or
Medicare entitlement, then the Plan Administrator must provide Qualified Beneficiaries with notification of their COBRA
continuation coverage rights, or the unavailability of COBRA rights, within 44 days of the event. If the Employer is not the Plan
Administrator, then the Employer's notification to the Plan Administrator must occur within 30 days of the Qualifying Event and the
Plan Administrator must provide Qualified Beneficiaries with their COBRA rights notice within 14 days thereafter. Notice to
Qualified Beneficiaries must be provided in person or by first-class mail unless otherwise agreed.
If COBRA continuation coverage terminates early (e.g. the Employer ceases to provide any group health coverage, a Qualified
Beneficiary fails to pay a required premium in a timely manner, or a Qualified Beneficiary becomes entitled to Medicare after the
date of the COBRA election, etc.), the Plan Administrator must provide the Qualified Beneficiary(ies) with notification of such early
termination. Notice must include the reason for early termination, the date of termination, and any right to alternative or
conversion coverage. The early termination notice(s) must be sent as soon as practicable after the decision that coverage should be
terminated.
Each Qualified Beneficiary, including a child who is born to or placed for adoption with an employee during a period of COBRA
continuation coverage, has a separate right to receive a written election notice when a Qualifying Event has occurred which permits
him/her to exercise coverage continuation rights under COBRA. However, where more than one Qualified Beneficiary resides at the
same address, the notification requirement will be met with regard to all such Qualified Beneficiaries if one election notice is sent
to that address, by first-class mail, with clear identification of those beneficiaries who have separate and independent rights to
COBRA continuation coverage unless delivery to that household has been otherwise agreed.
An employee or Qualified Beneficiary is responsible for notifying the Plan of a Qualifying Event that is a dependent child's ceasing
to be eligible under the requirements of the Plan, or the divorce or legal separation of the employee from his/her spouse. A
Qualified Beneficiary is also responsible for other notifications. See the COBRA Notice Requirements for Plan Participants in the
IMPORTANT NOTICES section (or see the employer's “COBRA General Notice” or &ldquoInitial Notice&rdquo) for further details and
time limits imposed on such notifications. Upon receipt of a notice, the Plan Administrator must notify the Qualified Beneficiary(ies)
of their continuation rights within 14 days. The notification must include the name and contact information of the employee, the
name(s) of the Qualified Beneficiary, the address and phone number of the Qualified Beneficiary, the Qualifying Event, and the
date the Qualifying Event occurred (e.g., the date of divorce), and, if necessary, proof of the Qualifying Event (e.g., in the case of
divorce or legal separation, the applicable court order).
You can send any questions or requests related to COBRA or state continuation coverage to cobra@gusto.com or by calling (800)
936-0383.
Election and Election Period
COBRA continuation coverage may be elected during the period beginning on the date Plan coverage would otherwise terminate
due to a Qualifying Event and ending on the later of the following: (1) 60 days after coverage ends due to a Qualifying Event, or (2)
60 days after the notice of the COBRA continuation coverage rights is provided to the Qualified Beneficiary. Failure to make a
COBRA election within the 60-day period will result in the inability to elect COBRA continuation coverage. See NOTE.
If the COBRA election of a covered employee or spouse does not specify “self-only” coverage, the election is deemed to include an
election on behalf of all other Qualified Beneficiaries with respect to the Qualifying Event. However, each Qualified Beneficiary who
would otherwise lose coverage is entitled to choose COBRA continuation coverage, even if others in the same family have declined.
A parent or legal guardian may elect or decline for minor dependent children.
An election of an incapacitated or deceased Qualified Beneficiary can be made by the legal representative of the Qualifying
Beneficiary or the Qualified Beneficiary's estate, as determined under applicable state law, or by the spouse of the Qualified
Beneficiary.
If, during the election period, a Qualified Beneficiary waives COBRA continuation coverage rights, the waiver can be revoked at any
time before the end of the election period. Revocation of the waiver will be an election of COBRA continuation coverage. However,
if a waiver is revoked, coverage need not be provided retroactively (that is, from the date of the loss of coverage until the waiver is
revoked). Waivers and revocations of waivers are considered to be made on the date they are sent to the employer or Plan
Administrator.
Where open enrollment rights allow Non-COBRA Beneficiaries to choose among any available coverage options, such rights are
also applicable to each Qualified Beneficiary. Similarly, the Special Enrollment Rights of HIPAA extend to Qualified Beneficiaries.
However, if a former Qualified Beneficiary did not elect COBRA, he/she does not have Special Enrollment Rights, even though active
employees not participating in the Plan have such rights under HIPAA.
The Plan is required to make a complete response to any inquiry from a healthcare provider regarding a Qualified Beneficiary's
right to coverage during the election period.
NOTE: See the Effect of the Trade Act provision for information regarding a second 60-day election period allowance.
Effective Date of Coverage
COBRA continuation coverage, if elected within the period allowed for such election, is effective retroactively to the date coverage
would otherwise have terminated due to the Qualifying Event, and the Qualified Beneficiary will be charged for coverage in this
retroactive period.
See “Election and Election Period” for an exception to the above when a Qualified Beneficiary initially waives COBRA continuation
coverage and then revokes his/her waiver. In that instance, COBRA continuation coverage is effective on the date the waiver is
revoked.
Level of Benefits
COBRA continuation coverage will be equivalent to coverage provided to similarly situated Non-COBRA Beneficiaries to whom a
Qualifying Event has not occurred. If coverage is modified for similarly situated Non-COBRA Beneficiaries, the same modification
will apply to Qualified Beneficiaries.
If the Plan includes a deductible requirement, a Qualified Beneficiary's deductible amount at the beginning of the COBRA
continuation period must be equal to his/her deductible amount immediately before that date. If the deductible is computed on a
family basis, only the expenses of those family members electing COBRA continuation coverage are carried forward to the COBRA
continuation coverage. If more than one family unit results from a Qualifying Event, the family deductibles are computed
separately based on the members in each unit. Other Plan limits are treated in the same manner as deductibles.
If a Qualified Beneficiary is participating in a region-specific health plan that will not be available if the Qualified Beneficiary
relocates, any other coverage that the Plan Sponsor makes available to active employees and that provides service in the relocation
area must be offered to the Qualified Beneficiary.
Cost of Continuation Coverage
The cost of COBRA continuation coverage is fixed in advance for a 12-month determination period and will not exceed 102% of the
Plan's full cost of coverage during the period for similarly situated Non-COBRA Beneficiaries to whom a Qualifying Event has not
occurred. The “full cost” includes any part of the cost which is paid by the employer for Non-COBRA Beneficiaries. Qualified
Beneficiaries will be charged 150% of the full cost for the 11-month disability extension period if the disabled person is among
those extending coverage.
The initial “premium” (cost of coverage) payment must be made within 45 days after the date of the COBRA election by the
Qualified Beneficiary. If payment is not made within such time period, the COBRA election is null and void. The initial premium
payment must cover the period of coverage from the date of the COBRA election retroactive to the date of loss of coverage due to
the Qualifying Event (or the date a COBRA waiver was revoked, if applicable). Contributions for successive periods of coverage are
due on the first of each month thereafter, with a 30-day grace period allowed for payment.
The Plan must allow the payment for COBRA continuation coverage to be made in monthly installments but the Plan is also
permitted to allow for payment at other intervals. The Plan is not obligated to send monthly premium notices.
The cost of COBRA continuation coverage can only increase during the Plan's 12-month determination period if:
the cost previously charged was less than the maximum permitted by law;
the increase occurs due to a disability extension (i.e. the 11-month disability extension) and does not exceed the maximum
permitted by law which is 150% of the Plan's full cost of coverage if the disabled person is among those extending coverage;
or
the Qualified Beneficiary changes his/her coverage option(s) which results in a different coverage cost.
Timely payments which are less than the required amount but are not significantly less (an “insignificant shortfall”) will be deemed
to satisfy the Plan's payment requirement. The Plan may notify the Qualified Beneficiary of the deficiency but must grant a
reasonable period of time (at least 30 days) to make full payment. A payment will be considered an “insignificant shortfall” if it is
not greater than $50 or 10% of the required amount, whichever is less.
If premiums are not paid by the first day of the period of coverage, the Plan has the option to cancel coverage until payment is
received and then reinstate the coverage retroactively to the beginning of the period of coverage.
NOTES: For Qualified Beneficiaries who reside in a state with a health insurance premium payment program, the State may pay the
cost of COBRA coverage for a Qualified Beneficiary who is eligible for health care benefits from the State through a program for
the medically-indigent or due to a certain disability. The employer's benefits department should be contacted for additional
information.
Maximum Coverage Periods
The maximum coverage periods for COBRA continuation coverage are based on the type of Qualifying Event and the status of the
Qualified Beneficiary and are as follows:
if the Qualifying Event is a termination of employment or reduction of hours of employment, the maximum coverage period
is 18 months after the loss of coverage due to the Qualifying Event. With a disability extension (see “Disability Extension”
information below), the 18 months is extended to 29 months;
if the Qualifying Event occurs to a dependent due to employee's enrollment in the Medicare program before the employee
himself/herself experiences a Qualifying Event, the maximum coverage period for the dependent is 36 months from the
date the employee is enrolled in Medicare;
for any other Qualifying Event, the maximum coverage period ends 36 months after the date of loss of coverage due to the
Qualifying Event.
If a Qualifying Event occurs which provides an 18-month or 29-month maximum coverage period and is followed by a second
Qualifying Event that allows a 36-month maximum coverage period, the original period will be expanded to 36 months, but only for
individuals who are Qualified Beneficiaries at the time of both Qualifying Events. Thus, a termination of employment following a
Qualifying Event that is a reduction of hours of employment will not expand the maximum COBRA continuation period. In no
circumstance can the COBRA maximum coverage period be more than 36 months after the date of the first Qualifying Event.
COBRA entitlement runs concurrently with continuation of coverage under The Uniformed Services Employment and
Reemployment Rights Act of 1994 (USERRA) - USERRA does not extend the maximum period of COBRA coverage. If coverage is
continued under USERRA, the equivalent number of months of COBRA entitlement will be exhausted.
Disability Extension
An 11-month disability extension (an extension from a maximum 18 months of COBRA continuation coverage to a maximum 29
months) will be granted if a Qualified Beneficiary is determined under Title II or XVI of the Social Security Act to be disabled during
the first 60 days of COBRA continuation coverage. To qualify for the disability extension, the Plan Administrator must be provided
with notice of the Social Security Administration's disability determination date which falls within the allowable periods described.
The notice must be provided within 60 days of the disability determination and prior to expiration of the initial 18-month COBRA
continuation coverage period. The disabled Qualified Beneficiary or any Qualified Beneficiaries in his/her family may notify the Plan
Administrator of the determination. The notice of disability extension must include the name of the employee, name of the
Qualified Beneficiary who is disabled, the Qualified Beneficiary electing the extension, and a copy of the Social Security
Administration's determination of disability. The Plan must also be notified if the Qualified Beneficiary is later determined by Social
Security to be no longer disabled.
If an individual who is eligible for the 11-month disability extension also has family members who are entitled to COBRA
continuation coverage, those family members are also entitled to the 29-month COBRA continuation coverage period. This applies
even if the disabled person does not elect the extension himself/herself.
Termination of Continuation Coverage
Except for an initial interruption of Plan coverage in connection with a waiver (see “Election and Election Period” above), COBRA
continuation coverage that has been elected by or for a Qualified Beneficiary will extend for the period beginning on the date of
the loss of coverage due to the Qualifying Event and ending on the earliest of the following dates:
the last day of the applicable maximum coverage period - see “Maximum Coverage Periods” above;
the date on which the employer ceases to provide any group health plan to any employee;
the date, after the date of the COBRA election, that the Qualified Beneficiary first becomes covered under any other plan
that does not contain any exclusion or limitation with respect to any pre-existing condition that would reduce or exclude
benefits for such condition in the Qualified Beneficiary;
the date, after the date of the COBRA election, that the Qualified Beneficiary becomes entitled to Medicare benefits. For
COBRA purposes, “entitled” means that the Medicare enrollment process has been completed with the Social Security
Administration and the individual has been notified that his/her Medicare coverage is in effect;
in the case of a Qualified Beneficiary entitled to a disability extension, the later of:
29 months after the date of the Qualifying Event, or the first day of the month that is more than 30 days after the
date of a final determination under Title II or XVI of the Social Security Act that the disabled Qualified Beneficiary
whose disability resulted in the Qualified Beneficiary's entitlement to the disability extension is no longer disabled,
whichever is earlier; or
the end of the maximum coverage period that applies to the Qualified Beneficiary without regard to the disability
extension;
the end of the last period for which the cost of continuation coverage is paid, if payment is not received in a timely
manner (i.e. coverage may be terminated if the Qualified Beneficiary is more than 30 days delinquent in paying the
applicable premium). The Plan is required to make a complete response to any inquiry from a healthcare provider
regarding a Qualified Beneficiary's right to coverage during any period the Plan has not received payment.
The Plan Sponsor can terminate, for cause, the coverage of any Qualified Beneficiary on the same basis that the Plan may
terminate the coverage of similarly-situated Non-COBRA Beneficiaries for cause (e.g., for the submission of a fraudulent claim).
If an individual is receiving COBRA continuation coverage solely because of the person's relationship to a Qualified Beneficiary (i.e.
a newborn or adopted child acquired during an employee's COBRA coverage period), the Plan's obligation to make COBRA
continuation coverage available will cease when the Plan is no longer obligated to make COBRA continuation coverage available to
the Qualified Beneficiary.
Effect of the Trade Act
In response to Public Law 107-210, referred to as the Trade Act of 2002 (“TAA”), the Plan is deemed to be “Qualified Health
Insurance” pursuant to TAA, the Plan provides COBRA continuation of coverage in the manner required of the Plan by TAA for
individuals who suffer loss of their medical benefits under the Plan due to foreign trade competition or shifts of production to
other countries, as determined by the U.S. International Trade Commission and the Department of Labor pursuant to the Trade Act
of 1974, as amended.
Eligible Individuals
The Plan Administrator shall recognize those individuals who are deemed eligible for federal income tax credit of their health
insurance cost or who receive a benefit from the Pension Benefit Guaranty Corporation (“PBGC”), pursuant to TAA as of or after
November 4, 2002. The Plan Administrator shall require documentation evidencing eligibility of TAA benefits, including but not
limited to, a government certificate of TAA eligibility, a PBGC benefit statement, federal income tax filings, etc. The Plan need not
require every available document to establish evidence of TAA eligibility. The burden for evidencing TAA eligibility is that of the
individual applying for coverage under the Plan. The Plan shall not be required to assist such individuals in gathering such
evidence.
Temporary Extension of COBRA Election Period
In the case of an otherwise COBRA Qualified Beneficiary who is a Non-electing TAA-Eligible Individual (see “Definitions”, below),
such individual may elect COBRA continuation of coverage during the TAA-Related Election Period, but only if such election is made
not later than 6 months after the date of the TAA-Related Loss of Coverage.
Any continuation of coverage elected by a TAA-Eligible Individual shall commence at the beginning of the TAA Related Election
Period, and shall not include any period prior to such individual's TAA-Related Election Period.
Definitions:
1. Non-electing TAA-Eligible Individual. ATAA-Eligible Individual who has a TAA related loss of coverage and did not elect COBRA
continuation coverage during the TAA-Related Election Period.
2. TAA-Eligible Individual. An eligible TAA recipient and an eligible alternative TAA recipient.
3. TAA-Related Election Period. With respect to a TAA-related loss of coverage, the 60-day period that begins on the first day of
the month in which the individual becomes a TAA-Eligible Individual.
4. TAA-Related Loss of Coverage. Means, with respect to an individual whose separation from employment gives rise to being
a TAA-Eligible Individual, the loss of health benefits coverage associated with such separation.
Any continuation of coverage elected by a TAA-Eligible Individual shall commence at the beginning of the TAA-Related Election
Period, and shall not include any period prior to such individual's TAA-Related Election Period.
Applicable Cost of Coverage Payments
Payments of any portion of the applicable COBRA cost of coverage by the federal government on behalf of a TAA-Eligible Individual
pursuant to TAA shall be treated as a payment to the Plan. Where the balance of any contribution owed the Plan by such individual
is determined to be significantly less than the required applicable cost of coverage, as explained in IRS regulations 54.4980B-8, A-
5(d), the Plan will notify such individual of the deficient payment and allow thirty (30) days to make full payment. Otherwise the
Plan shall return such deficient payment to the individual and coverage will terminate as of the original cost of coverage due date.
Conversion
If the Plan Sponsor offers a conversion privilege to Non-COBRA Beneficiaries and in conjunction with the health benefits of the
Plan, then a Qualified Beneficiary has the right to exercise the conversion option when he/she reaches the end of his/her COBRA
continuation coverage.
The option to enroll in the conversion health plan must be given within 180 days before COBRA coverage ends. The premium for a
conversion policy may be more expensive than the cost of COBRA coverage or the cost of Plan coverage. Also, the conversion
policy may provide a lower level of coverage.
The conversion option is not available if the Qualified Beneficiary terminates COBRA coverage before reaching the end of the
maximum period of COBRA coverage.
Section 8 Claims and Appeals Procedure

The insurers and HMOs listed in Exhibit A are responsible for determining all claims and appeals of denied claims under the Plan in
accordance with their respective reasonable claims procedure as required by ERISA. Please refer to the EOC or COC for a
description of the procedure for filing claims and appealing any denied claims. For self-insured benefits or coverages, please refer
to the applicable exhibit to this document for the applicable claims and appeals procedure.
Exhibit A
List of Benefits, Coverages, and Insurers

The following is a list of all health and welfare plan coverages available under the Plan. Such benefits are available to you if you are
enrolled in the applicable coverage and meet all other requirements for the benefit or coverage as provided in the applicable EOC
or COC. You must be properly enrolled in the applicable coverage and meet all other requirements for such benefit as provided in
the applicable plan document.
Principal Vision Plan 2

Plan Number: 501
Insurer or HMO: Principal
Insurer or HMO Address: Principal, 2121 North California Blvd Suite 301 , Walnut Creek, CA 94596
Insurer or HMO Phone Number: (800) 247-4695
General Description of Benefits: Provides vision insurance in accordance with detailed schedules of benefits which are included as
part of the Benefit Documents received during enrollment.
Funding: Fully-Insured.
Plan Year: 2020-03-01 to 2021-02-28.
Waiting Period: First of month 30 days after hire
Guardian EM Dental 15
Plan Number: 501
Insurer or HMO: Guardian
Insurer or HMO Address: Guardian, P.O. Box 14319, Lexington, KY 40512
General Description of Benefits: Provides dental insurance in accordance with detailed schedules of benefits which are included as
Plan Year: 2020-03-01 to 2021-02-28.
Anthem Silver PPO 45/1750/40% [4HXN]

Plan Number: 501
Insurer or HMO: Anthem Blue Cross of California
Insurer or HMO Address: Anthem Blue Cross of California, 2000 Corporate Center Drive, Newbury Park, CA 91320
General Description of Benefits: Provides medical insurance in accordance with detailed schedules of benefits which are included
as part of the Benefit Documents received during enrollment.
Plan Year: 2020-03-01 to 2021-02-28.

Anthem Gold PPO 20/30% 4HW6
Plan Number: 501
Plan Year: 2020-03-01 to 2021-02-28.
Anthem Silver PPO 2000/30% w/HSA - RxC 4HVU

Plan Number: 501
Plan Year: 2020-03-01 to 2021-02-28.
Anthem Bronze PPO 6600/0% w/HSA - 52SM

Plan Number: 501
Plan Year: 2020-03-01 to 2021-02-28.
Anthem Gold HMO 35 - 4HUV

Plan Number: 501
Plan Year: 2020-03-01 to 2021-02-28.

Guardian EM LTD 1A (CA-CS)

Plan Number: 501
General Description of Benefits: Provides long term disability insurance in accordance with detailed schedules of benefits which
are included as part of the Benefit Documents received during enrollment.
Plan Year: 2020-03-01 to 2021-02-28.
Guardian EM Life 1F (CA-CS)

Plan Number: 501
General Description of Benefits: Provides life insurance in accordance with detailed schedules of benefits which are included as
Plan Year: 2020-03-01 to 2021-02-28.
Health Savings Account

Plan Number: Not subject to ERISA
Claim Administrator: Gusto
Claim Administrator Phone: (800) 936-0383
Claim Administrator Fax Number: (844) 791-8320
General Description of Benefits: Provides a health savings account in accordance with detailed schedules of benefits which are
included as part of the Benefit Documents received during enrollment.
Funding: Benefits are paid by third-party custodian, but are funded by employee contributions.
Plan Year: 2020-03-01 to 2021-02-28.

Exhibit B
Legal Notices
Statement of ERISA Rights

As a participant in the Plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of
1974 (ERISA). ERISA provides that all plan participants shall be entitled to (NOTE: This statement of ERISA Rights does not apply to
the dependent care flexible spending account, health savings account or commuter and transit benefit, if any of them are offered):
Receive Information About Your Plan and Benefits

Examine, without charge, at the plan administrator's office and at other specified locations, such as worksites and union halls, all
documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual
report (Form 5500 Series) filed by the plan with the U.S. Department of Labor and available at the Public Disclosure Room of the
Pension and Welfare Benefit Administration, if the Plan is subject to Form 5500 requirements.
Obtain, upon written request to the plan administrator, copies of documents governing the operation of the plan, including
insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series, if this is
applicable to the Plan) and updated summary plan description. The administrator may make a reasonable charge for the copies.
The plan administrator is required by law to furnish each participant with a copy of the summary annual report, if the Plan is
subject to this requirement.
Continue Group Health Plan Coverage

Continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the plan as a result of a
qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the
documents governing the plan on the rules governing your COBRA continuation coverage rights.
Prudent Actions by Plan Fiduciaries

In addition to creating rights for plan participants ERISA imposes duties upon the people who are responsible for the operation of
the employee benefit plan. The people who operate your plan, called fiduciaries of the plan, have a duty to do so prudently and in
the interest of you and other plan participants and beneficiaries. No one, including your employer, or any other person, may fire
you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights
under ERISA.
Enforce Your Rights

If your claim for a welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain
copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.
Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the
latest annual report from the plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the
court may require the plan administrator to provide the materials and pay you up to $147 a day until you receive the materials,
unless the materials were not sent because of reasons beyond the control of the administrator.
If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. In
addition, if you disagree with the plan's decision or lack thereof concerning the qualified status of a domestic relations order or a
medical child support order, you may file suit in Federal court.
If it should happen that plan fiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you
may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should
pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If
you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.
Assistance with Your Questons

If you have any questions about your plan, you should contact the plan administrator. If you have any questions about this
statement or about your rights under ERISA, or if you need assistance in obtaining documents from the plan administrator, you
should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your
telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S.
Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your
rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.
Note Regarding Premium Assistance Under Medicaid and the Children's Health Insurance
Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you're eligible for health coverage from your employer, your state may
have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or
your children aren't eligible for Medicaid or CHIP, you won't be eligible for these premium assistance programs but you may be
able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit
www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State
Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be
eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or
www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay
the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer
plan, your employer must allow you to enroll in your employer plan if you aren't already enrolled. This is called a “special
enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you
have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-
EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The
following list of States is current as of January 31, 2016. You should contact your State for further information on eligibility:
ALABAMA - Medicaid
Website: www.myalhipp.com
Phone: 1-855-692-5447
ALASKA - Medicaid
Website: http://health.hss.state.ak.us/dpa/programs/medicaid/
Phone (Outside of Anchorage): 1-888-318-8890
Phone (Anchorage): 907-269-6529
COLORADO - Medicaid
Medicaid Website: http://www.colorado.gov/hcpf
Medicaid Customer Contact Center: 1-800-221-3943
FLORIDA - Medicaid
Website: https://www.flmedicaidtplrecovery.com/
Phone: 1-877-357-3268
GEORGIA - Medicaid
Website: http://dch.georgia.gov/medicaid
Click on Health Insurance Premium Payment (HIPP)
Phone: 404-656-4507
INDIANA - Medicaid
Healthy Indiana Plan for low-income adults 19-64
Website: http://www.hip.in.gov
Phone: 1-877-438-4479
All other Medicaid
Website: http://www.indianamedicaid.com
Phone: 1-800-403-0964
IOWA - Medicaid
Website: www.dhs.state.ia.us/hipp/
Phone : 1-888-346-9562
KANSAS - Medicaid
Website: http://www.kdheks.gov/hcf/
Phone: 1-785-296-3512
KENTUCKY - Medicaid
Website: http://chfs.ky.gov/dms/default.htm
Phone: 1-800-635-2570
LOUISIANA - Medicaid
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
Phone: 1-888-695-2447
MAINE - Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html
Phone: 1-800-442-6003
TTY: Maine relay 711
MASSACHUSETTS - Medicaid and CHIP
Website: http://www.mass.gov/MassHealth
Phone: 1-800-462-1120
MINNESOTA - Medicaid
Website: http://mn.gov/dhs/ma/
Phone: 1-800-657-3739
MISSOURI - Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573-751-2005
MONTANA - Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084
NEBRASKA - Medicaid
Website: http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspx
Phone: 1-855-632-7633
NEVADA - Medicaid
Medicaid Website: http://dwss.nv.gov
Medicaid Phone: 1-800-992-0900
NEW HAMPSHIRE - Medicaid
Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf
Phone: 603-271-5218
NEW JERSEY - Medicaid and CHIP
Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/
Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710
NEW YORK - Medicaid
Website: http://www.nyhealth.gov/health_care/medicaid/
Phone: 1-800-541-2831
NORTH CAROLINA - Medicaid
Website: http://www.ncdhhs.gov/dma
Phone: 919-855-4100
NORTH DAKOTA - Medicaid
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 1-844-854-4825
OKLAHOMA - Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
OREGON - Medicaid
Website: http://www.oregonhealthykids.gov
http://www.hijosaludablesoregon.gov
Phone: 1-800-699-9075
PENNSYLVANIA - Medicaid
Website: http://www.dhs.pa.us/hipp
Phone: 1-800-692-7462
RHODE ISLAND - Medicaid
Website: www.eohhs.ri.gov
Phone: 401-462-5300
SOUTH CAROLINA - Medicaid
Website: http://www.scdhhs.gov
Phone: 1-888-549-0820
SOUTH DAKOTA - Medicaid
Website: http://dss.sd.gov
Phone: 1-888-828-0059
TEXAS - Medicaid
Website: https://www.gethipptexas.com/
Phone: 1-800-440-0493
UTAH - Medicaid and CHIP
Medicaid: http://health.utah.gov/medicaid
CHIP: http://health.utah.gov/chip
Phone: 1-877-543-7669
VERMONT - Medicaid
Website: http://www.greenmountaincare.org/
Phone: 1-800-250-8427
VIRGINIA - Medicaid and CHIP
Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm
Medicaid Phone: 1-800-432-5924
CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm
CHIP Phone: 1-855-242-8282
WASHINGTON - Medicaid
Website: http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx
Phone: 1-800-562-3022 ext. 15473
WEST VIRGINIA - Medicaid
Website: www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx
Phone: 1-877-598-5820, HMS Third Party Liability
WISCONSIN - Medicaid
Website: http://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
Phone: 1-800-362-3002
WYOMING - Medicaid
Website: https://wyequalitycare.acs-inc.com/
Phone: 307-777-7531
To see if any more States have added a premium assistance program since January 31, 2016, or for more information on special
enrollment rights, you can contact either:
U.S. Department of Labor - Employee Benefits Security Administration, www.dol.gov/ebsa, 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services - www.cms.hhs.gov, 1-877-267-2323,
Menu Option 4, Ext. 61565
Wellness Program Notice of Availability of Reasonable Alternative Disclosures

Your health plan is committed to helping you achieve your best health. Any rewards for participating in a wellness program are
available to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you
might qualify for an opportunity to earn the same reward by different means. Contact the plan administrator using the contact
information in your plan documents above and we will work with you (and if you wish, your doctor) to find a wellness program with
the same reward that is right for you in light of your health status.
Women's Health and Cancer Rights Act (WHCRA) Annual Notice

Do you know that your plan, as required by the Women's Health and Cancer Rights Act of 1998, provides benefits for mastectomy-
related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and
complications resulting from a mastectomy, including lymphedema? Contact the plan administrator using the contact information
in your plan documents above for more information.
Newborn's and Mother's Health Protection Act (NMHPA)

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of
stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96
hours following a cesarean section. However, Federal law generally does not prohibit the mother's or newborn's attending
provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as
applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or
the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Continuation Coverage Rights under COBRA

Introduction
You're getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important
information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This
notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to
protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that
may cost less than COBRA continuation coverage.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of
1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health
coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you
should review the Plan's Summary Plan Description or contact the Plan Administrator. This plan may or may not be subject to
Federal COBRA or State Continuation Rights.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an
individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for
lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment
period for another group health plan for which you are eligible (such as a spouse's plan), even if that plan generally doesn't accept
late enrollees.
What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also
called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation
coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could
become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified
beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.
If you're an employee, you'll become a qualified beneficiary if you lose your coverage under the Plan because of the following
qualifying events:
Your hours of employment are reduced, or
Your employment ends for any reason other than your gross misconduct.
If you're the spouse of an employee, you'll become a qualified beneficiary if you lose your coverage under the Plan because of the
following qualifying events:
Your spouse dies;
Your spouse's hours of employment are reduced;
Your spouse's employment ends for any reason other than his or her gross misconduct;
Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following
qualifying events:
The parent-employee dies;
The parent-employee's hours of employment are reduced;
The parent-employee's employment ends for any reason other than his or her gross misconduct;
The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
The parents become divorced or legally separated; or
The child stops being eligible for coverage under the Plan as a “dependent child.”
When is COBRA continuation coverage available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that
a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:
The end of employment or reduction of hours of employment;
Death of the employee; or
The employee's becoming entitled to Medicare benefits (under Part A, Part B, or both).
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child's losing eligibility for
coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. The
notification must include the name and contact information of the employee, the name(s) of the Qualified Beneficiary, the address
and phone number of the Qualified Beneficiary, the Qualifying Event, the date the Qualifying Event occurred (e.g., the date of
divorce), and, if necessary, proof of the Qualifying Event (e.g., in the case of divorce or legal separation, the applicable court order).
How is COBRA continuation coverage provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to
each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage.
Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA
continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment
termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of
coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan
Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA
continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of
COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. The
notice of disability extension must include the name of the employee, name of Qualified Beneficiary who is disabled, the Qualified
Beneficiary electing the extension, and a copy of the Social Security Administration's determination of disability.
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and
dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36
months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any
dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare
benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the
Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or
dependent child to lose coverage under the Plan had the first qualifying event not occurred.
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through
the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse's plan) through what is
called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more
about many of these options at www.healthcare.gov.
If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts
identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including
COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional
or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit
www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.) For
more information about the Marketplace, visit www.HealthCare.gov.
Keep your Plan informed of address changes
To protect your family's rights, let the Plan Administrator know about any changes in the addresses of family members. You should
also keep a copy, for your records, of any notices you send to the Plan Administrator.
Plan contact information
You can send any questions or requests related to COBRA or state continuation coverage to cobra@gusto.com or by calling (800)
936-0383.
Forfeitures, Grace Period and Use It or Lose It Rule

Grace Period. You can incur expenses during the 2 1/2 month “grace period” that follows the end of the Plan Year and receive
reimbursements from any funds that remain in your General Purpose Health FSA or Limited Purpose Health FSA account on the
last day of the Plan Year. For example, if you are covered by a calendar year Health FSA, the Grace Period for the 2016 Plan Year is
the period from January 1, 2017 through March 15, 2017. If $300 remains in your Health FSA account on December 31, 2016, you
may incur expenses from January 1, 2017 through March 15, 2017 and be reimbursed from the $300 that remains in your Health
FSA account. Reimbursements for expenses incurred during a Grace Period may be made if: (1) you are an employee who has a
balance in your General Purpose Health FSA or Limited Purpose Health FSA account on the last day of the Plan Year that
immediately precedes the applicable Grace Period; or (2) you are a COBRA “qualified beneficiary” who has COBRA coverage under
the General Purpose Health FSA or Limited Purpose Health FSA on the last day of the Plan Year that immediately precedes the
applicable Grace Period. The following additional rules apply to the Grace Period:
Any balance that remains in your General Purpose Health FSA or Limited Purpose Health FSA account at the end of a Plan
Year may not be converted to any other taxable or non-taxable benefit or to cash (for example, it cannot reimburse
Dependent Care Expenses);
If you elected (or are deemed to have elected) to participate in the Health FSA in consecutive Plan Years, expenses incurred
during the Grace Period will be reimbursed first from any available funds relating to the General Purpose Health FSA or
Limited Purpose Health FSA account balance remaining for the Plan Year to which the Grace Period relates and then from
the funds in the General Purpose Health FSA or Limited Purpose Health FSA account for the current Plan Year. For example,
if you participated in a calendar year General Purpose Health FSA for the 2016 Plan Year and have a balance of $300 on
December 31, 2016 and elected to contribute to the General Purpose Health FSA for the 2017 Plan Year, any expense that
you incur during the Grace Period from January 1, 2017 through March 15, 2017 will be reimbursed from the $300 balance
relating to the 2016 General Purpose Health FSA account first.
Any amount that remains in your General Purpose Health FSA or Limited Purpose Health FSA account on the last day of the
Grace Period will be automatically forfeited unless you have timely submitted reimbursement requests for claims incurred
during the applicable Plan Year and related Grace Period. Reimbursement requests must be submitted to the Claims
Administrator no later than 3-months after the last day of the Grace Period. For example, for a Grace Period that ends on
March 15, reimbursement requests must be made no later than June 15.
Use of Forfeitures. Any amounts forfeited for any particular Plan Year will be used in the following order: (1) offset reimbursement
losses incurred by the Employer during the Plan Year; (2) to pay the reasonable expenses of maintaining and administering the
Plan; and (3) provide increased benefits or compensation to participants for the subsequent Plan Year on a reasonable and
uniform basis, consistent with applicable regulations. Any expense reimbursements remaining unclaimed (e.g., uncashed checks)
after the end of the Plan Year in which the expense was incurred will be forfeited and used in the manner described immediately
above.
Qualified Reservist Distributions. If you are called to active duty in the military for a period of 180 days or more or if the leave is
indefinite, the Health FSA may make a Qualified Reservist Distribution (QRD) to you if you provide the Plan with a copy of your
order or call to active duty. If the period specified is less than 180 days, a QRD will not be permitted unless subsequent calls or
orders increase the total period of active duty to 180 days or more. A QRD may be made in the amount contributed to the Health
FSA as of the date of the QRD request, minus reimbursements paid as of the date of the QRD request. Additional claims may not
be submitted for expenses incurred after the date a QRD is requested. The Health FSA will pay the QRD to you within a reasonable
time, but not more than 60 days after the request for the QRD has been made. A QRD may not be made with respect to a Plan Year
ending before the order or call to active duty.
Exhibit C
Health Savings Account (“HSA”)

This section describes the Health Savings Account feature which applies to employees whose Employer makes a high deductible
health plan/health savings account (“HDHP/HSA”) medical plan option available to its employees (see Exhibit A to see if a
“HDHP/HSA” medical plan option and HSA are available to you). If you enroll in HDHP/HSA and open an HSA, you can use the HSA
to pay for certain out-of-pocket health care expenses, now and in the future.
The HSA is a tax-preferred account that you own – it is portable and you decide how you wish to use it. You own and manage your
HSA and decide when and how to spend your HSA funds. Unused funds continue to grow tax-free and can stay in the account year
after year. You can accumulate an unlimited amount in your account and there is no “use it or lose it” rule. Your HSA account is an
FDIC-insured cash account and earns interest.
Contributions to an HSA
If you enroll in a HDHP/HSA medical plan option under the 3DEO Inc Health and Welfare Benefit Plan, you may open an HSA
account in your name with the HSA administrator that has been selected by your Employer and you may make contributions up to
the amount permitted by Internal Revenue Code Section 223 on a pre-tax basis. It is your responsibility to provide all necessary
information required to open your HSA account with the HSA administrator. Failure to do so could result in contributions payable
directly to you as taxable income via paycheck. While you are free to open an HSA wherever you want, pre-tax contributions you
have elected to make will only be made to the HSA administrator selected by your Employer. Note: You may change your pre-tax
contributions to your HSA each month during the year.
If you contribute more than the maximum allowed, the additional funds will be considered taxable income and you may need to
make adjustments on your annual tax filing with the IRS.
Total HSA contribution allowed by the IRS in 2017:

Individual: $3,400
Employee with dependent(s): $6,750
Employees age 55 and over may contribute an additional $1,000 each year to their HSA.
What Can the HSA Reimburse?

To receive reimbursement from your HSA, contact the HSA Administrator. The HSA can reimburse Internal Revenue Code Section
213(d) medical expenses. Eligible HSA expenses include:
Your plan deductible;
Medical, prescription drug, dental and vision expenses not reimbursed by a health plan or insurance;
Over-the-counter medications (only if prescribed by physician or is insulin);
Medicare premiums, deductibles, coinsurance and copayments;
Long-term care medical expenses and insurance premiums;
COBRA premiums;
Health insurance plan premiums only while you receive federal or state unemployment insurance.
Please refer to this IRS resource for further information: http://www.irs.gov/publications/p502.
If you are reimbursed for an improper expense from your HSA, a 20% tax penalty will be imposed on you by the Internal Revenue
Service - this is in addition to the income tax that will be assessed on the distribution).
HSA Eligibility
To contribute to an HSA, you must meet all of the following requirements:
Be enrolled in the HDHP/HSA medical plan option;
Not be covered by any other medical plan that is not a high-deductible medical plan, even if it is through a spouse's
coverage;
Not be enrolled in Medicare;
Cannot be claimed as a dependent on someone else's tax return;
Not be enrolled in a health care flexible spending account (FSA), other than a Limited Purpose Health FSA (you are
considered to be covered by an FSA if your spouse is enrolled in an FSA at his or her employer).

Section 1 Section 1 Introduction: Effective As of March 1, 2020

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3DEO Inc Health and Welfare Benefit Plan - Wraparound

Summary Plan Description (“SPD”) and Plan Document

Section 2 General Information About Plan

Plan Number: 501

Plan Administrator and Plan Sponsor:

Plan Sponsor's Employer Identification Number: 812701081

Agent for Service of Legal Process:

Plan Effective Date: March 1, 2020

Plan Funding and Source of Contributions

Amendment and Termination

Section 3 Plan Benefits

Section 5 Enrollment and Effective Date of Coverage

You or your dependent exhaust COBRA coverage under another plan;

Section 6 Coverage Disqualification, Ineligibility, Termination or Loss

Section 7 COBRA or State Continuation Coverage

for an employee's spouse or child, the death of the covered employee;

Election and Election Period

Effective Date of Coverage

Cost of Continuation Coverage

Maximum Coverage Periods

Termination of Continuation Coverage

Effect of the Trade Act

Temporary Extension of COBRA Election Period

Applicable Cost of Coverage Payments

Section 8 Claims and Appeals Procedure

List of Benefits, Coverages, and Insurers

Principal Vision Plan 2

Insurer or HMO: Principal

Insurer or HMO Phone Number: (800) 247-4695

Plan Year: 2020-03-01 to 2021-02-28.

Waiting Period: First of month 30 days after hire

Insurer or HMO: Guardian

Insurer or HMO Address: Guardian, P.O. Box 14319, Lexington, KY 40512

Insurer or HMO Phone Number: (800) 627-4200

Plan Year: 2020-03-01 to 2021-02-28.

Waiting Period: First of month 30 days after hire

Anthem Silver PPO 45/1750/40% [4HXN]

Insurer or HMO: Anthem Blue Cross of California

Insurer or HMO Phone Number: (855) 854-1429

Plan Year: 2020-03-01 to 2021-02-28.

Waiting Period: First of month 30 days after hire

Insurer or HMO: Anthem Blue Cross of California

Insurer or HMO Phone Number: (855) 854-1429

Plan Year: 2020-03-01 to 2021-02-28.

Waiting Period: First of month 30 days after hire

Anthem Silver PPO 2000/30% w/HSA - RxC 4HVU

Insurer or HMO: Anthem Blue Cross of California

Insurer or HMO Phone Number: (855) 854-1429

Plan Year: 2020-03-01 to 2021-02-28.

Waiting Period: First of month 30 days after hire

Anthem Bronze PPO 6600/0% w/HSA - 52SM

Insurer or HMO: Anthem Blue Cross of California

Insurer or HMO Phone Number: (855) 854-1429

Plan Year: 2020-03-01 to 2021-02-28.

Waiting Period: First of month 30 days after hire

Anthem Gold HMO 35 - 4HUV

Insurer or HMO: Anthem Blue Cross of California

Insurer or HMO Phone Number: (855) 854-1429

Plan Year: 2020-03-01 to 2021-02-28.

Guardian EM LTD 1A (CA-CS)

Insurer or HMO: Guardian

Insurer or HMO Address: Guardian, P.O. Box 14319, Lexington, KY 40512